Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Differential Diagnosis

Specialists

Gastroenterologist

Hematologist

Neurologist

Comorbid Conditions

Immune system disorders

Pancreatic insufficiency

Factors Influencing Duration

Duration depends on the severity of the anemia. The presence of neurologic problems, psychiatric symptoms, or autoimmune disorders can lengthen the period of disability. Whether the job requires significant physical activity or activities that require normal balance and gait may also influence the length of disability.

Medical Codes

Overview

Pernicious anemia is a type of anemia associated with impaired gastric absorption of vitamin B12, which is essential for red blood cell hemoglobin production. Because vitamin B12 is not made in the body in sufficient amounts, it must be absorbed from foods such as meat and eggs. In pernicious anemia, the inability to absorb vitamin B12 is due to the absence of a protein normally made in the stomach called intrinsic factor. It is more common in individuals with other autoimmune glandular deficiencies, including hypothyroidism and thyroiditis.

Pernicious anemia may also be seen in individuals who have had a large part of the stomach removed, which results in a loss of the cells that make intrinsic factor.

Incidence and Prevalence: The prevalence of pernicious anemia is nearly 2% of individuals over 60 years of age (Hart).

Causation and Known Risk Factors

Pernicious anemia occurs most often in older individuals and those of northern European descent. Individuals of English, Irish, Scottish, or Scandinavian origin have the highest risk. Females and males are equally affected in the US, although individuals from England, Scandinavia, and Africa show a female-to-male predominance ratio of 1.5 to 1 (Conrad).

The average age of onset is 40 to 70 years; there is a genetic predisposition for pernicious anemia (Conrad).

Diagnosis

History: Individuals with pernicious anemia, like those with other anemias, may have nonspecific symptoms such as fatigue, dizziness, shortness of breath, and decreased exercise capacity. Symptoms specific to pernicious anemia include a smooth, sore tongue (glossitis), numbness and tingling of the hands and feet (neuropathy), weakness, trouble with coordination and balance (ataxia), memory disturbances, and depression.

Physical exam: Physical features of pernicious anemia are those of vitamin B12 deficiency, including a smooth, "beefy red" tongue, an abnormal "broad-based" gait, imbalance, and a loss of vibration and position sense. Nonspecific features of the anemia may include pale skin and rapid respiratory and heart rates even at rest.

Tests: A complete blood count (CBC) shows low numbers of large red blood cells (macrocytic anemia) and sometimes low numbers of platelets and large white blood cells. The vitamin B12 level in the blood is low. Antibodies against the stomach cells (parietal cells) that make the intrinsic factor are almost always present. A bone marrow biopsy will show large numbers of large, immature red blood cells (megaloblastic erythroid hyperplasia). If a vitamin B12 deficiency is established, a Schilling test may help confirm the etiology.

Prognosis

If diagnosed early, most individuals see a rapid improvement in symptoms once treatment begins. However, neurologic symptoms may take months to improve, or they may progress and become permanent if the disease remains untreated for a long period of time.

Complications

There is an increased risk of developing stomach polyps and stomach cancer with pernicious anemia. It is also associated with other autoimmune disorders such as thyroid disease, gland insufficiency, and loss of skin pigment (vitiligo). Nonspecific complications of severe anemia include chest pain (angina pectoris) and congestive heart failure, especially in individuals with heart disease.

Women older than 65 years of age with pernicious anemia are twice as likely to sustain hip and spine fractures and are nearly 3 times as likely to sustain wrist fractures (Stone 1217).

Ability to Work (Return to Work Considerations)

Individuals with pernicious anemia may require a reduction in physical activity until the condition is adequately treated. Initially, the individual requires sufficient time off to receive weekly vitamin B12 injections, usually for about 6 weeks, and then proceeds to injections once a month.

If neurologic complications occur, individuals may require more sedentary work.

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

Does individual have a history that would place him/her at risk for developing pernicious anemia? What is individual's ethnic background? Has individual had a large part of the stomach removed?

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